Nygaard thought she was in good shape, with low body fat, controlled cholesterol and a lifetime of good health.
“I’d never missed a day of work in 18 years. I missed only one week after each baby. I never had anything ever,” she said of her medical history.
After numerous tests ruled out a structural defect, clotting disorder, leaking valve or other known causes of stroke, the doctors told her it was of unknown origin.
“I wasn’t accepting that as an answer,” she said. “My kids were 5 and 7. I knew my dad had cardiovascular disease. He had a heart attack by 40. My mom had heart disease. I knew I was a walking time bomb.”
So Nygaard went to the Heart Attack and Stroke Prevention Center, where, she said, a series of tests revealed her arteries were inflamed, putting her at high risk for another stroke.
After making numerous lifestyle changes to improve her cardiovascular health, including diet, exercise and medication, follow-up tests were discouraging.
“I was doing all those things and in spite of doing them my stroke risk wasn’t getting better,” Nygaard said.
That’s when medical director Amy Doneen asked about Nygaard’s dental care.
“I’m a gum dentist but I hadn’t had an appointment in three years,” admitted Nygaard, noting a subsequent saliva test showed she had high levels of oral bacteria that correlate with cardiac event risk. She also had bleeding gums.
“I had one pocket that had a sore that was bleeding. Most dentists ignore one sore that bleeds,” she said.
But after six weeks treating the gum disease, Nygaard said her stroke markers dropped from dangerous into the healthy zone.
“We believe her periodontal inflammation was part of the cascade,” said Doneen, a nurse practitioner. “It’s one piece of the pie.”
While Doneen looks at other factors that lead to cardiovascular disease and artery wall inflammation, she stressed that good oral health is crucial to overall health, especially cardiovascular health.
“There’s evidence that what goes on in the mouth has systemic implications,” she said, adding, “It’s never normal to have bleeding gums.”
Nygaard said many patients aren’t informed about their gum health and the risks that go up with inflamed, bleeding gums or high amounts of decay-causing bacteria. “A lot of dentists and hygienists don’t tell patients because they don’t believe it makes a difference,” she said.
Directors of the RIDE dental program at Riverpoint campus aim to change this with a holistic approach to dental education.
RIDE – Regional Initiatives in Dental Education – is a University of Washington School of Dentistry program that partners with Eastern Washington University and Washington State University. It offers professional education, where students learn alongside other future health care providers, including medical, pharmacology, physical therapy, occupational therapy, auditory, and dental hygiene.
“We’re trying to get the message out that the mouth isn’t separated from the rest of the body. You’re not going to be healthy unless you have a healthy mouth,” said Dr. Jim Sledge, RIDE’s regional clinical director.
Still, Sledge said, many people think oral health is only about teeth and cavities.
“There’s a larger concern with periodontal disease and cardiovascular health. What happens in the mouth can affect cardiac disease,” Sledge said.
In fact, Dr. Art DiMarco, Spokane director of RIDE, said studies show gum disease has a strong correlation to cardiovascular disease, putting people at higher risk of diabetes, heart attack and stroke.
A diabetic who has swollen or bleeding gums, for example, may have trouble controlling blood sugar. In turn, uncontrolled diabetes can contribute to gum inflammation.
For a pregnant woman, Sledge said, oral disease increases the risk of gestational diabetes as well as the prevalence of prostaglandin, a hormone that stimulates uterine contractions, which increases the odds of delivering a low-birth weight baby.
Additionally, he said, studies have shown that primary caregivers pass oral bacteria directly to their children. The mom who pops a pacifier in her mouth to clean it, for example, passes decay-causing bacteria to her child.
“There is direct transmission of bad bacteria that causes cavities. You have infected your baby,” he said, noting that’s another reason pregnant women should go to the dentist and address any oral issues. “Get moms in good oral condition before birth so there’s less chance of that transmission.”
Yet according to a recent survey by the Washington Dental Service Foundation, 23 percent of adults in Washington State haven’t had a dental check up in the last year.
While oral disease can be prevented and treated, DiMarco said it may go unchecked because, unlike an oozing forehead wound that would get immediate medical attention, bleeding or inflamed gums aren’t so visible.
“People can close their mouths and hide disease,” he said. “But it is disease.”
• Amy Doneen’s book,
“Beat the Heart Attack Gene”, co-authored with Dr. Bradley Bale, is available today, with a book signing Feb. 20, 7 p.m., Auntie’s Bookstore, 402 W. Main Ave. (509) 838-0206.
Tips to good oral health compiled from Dr. Art DiMarco, Dr. Jim Sledge, Amy Doneen and The Mighty Mouth Campaign.
• Brush with a fluoridated toothpaste twice a day. While brushing use gentle, circular motions for at least two minutes.
• Floss twice a day.
• Brush about 30 minutes after eating. The act of eating demineralizes the teeth some, said Sledge. The abrasive act of brushing immediately after eating can weaken tooth enamel. But saliva replenishes the teeth. Brushing after 30 minutes removes food that could contribute to decay.
• Chew sugarless gum that’s sweetened with xylitol. Bacteria in the mouth can’t use xylitol to produce acid that breaks down teeth. Xylitol also kills or prevents growth of bacteria that causes tooth decay. Additionally, chewing sugarless gum encourages saliva, which is the mouth’s natural protector. It replenishes calcium on the tooth enamel, for example.
• Go to the dentist at least once a year – more often if you have any form of gum disease, such as bleeding or swelling.
• Eat a healthy diet. Apple slices, nuts and string cheese are preferable to crackers, said Sledge, because they’re healthy and don’t stick to the teeth.
• Drink plenty of water. This washes away food and hydrates the mouth. This is especially important when taking antihistamines or any medication that reduces saliva.
• Brush or rinse teeth after taking an antacid. Sometimes people with gastric reflux suck on antacids throughout the night. This can greatly increase tooth decay, DiMarco said.
• Limit in-between meal snacking
• Don’t smoke or chew tobacco. This lowers the risk of oral cancer as well as gum disease. “The majority of cancers in the mouth occur due to smoking,” said DiMarco. Nygaard said any form of smoking is bad for the mouth but marijuana appears to be worse than cigarettes. “We don’t have a lot of data but the kind of disease I see with marijuana smokers is more aggressive and more invasive than cigarettes,” she said.
• Avoid soda and hard sugar candy. Both bathe the teeth in ingredients that promote tooth decay.
For more information go to www.themightymouth.org